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CT scan done after craniotomy for aneurysm repair. What does the reports mean?

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Neurologist, Surgical
Practicing since : 1997
Answered : 65 Questions
CT scan report says "There is a mild to moderate XXXXXXX white matter microvascular chronic ischemic change". This is compared to a CT scan done the day after a Craniotomy for aneurysm repair. What does that mean symptom wise?

This is a follow up exam to the craniotomy which was done six weeks ago. I've been have a number of issues most of which seem to be transient but three weeks ago vision issues developed and have been through a number of problems including photophobia, focus problems and some hand eye coordination problems.

The recent CT scan was compared to one done the day after the craniotomy. This one shows no bleeding but notes the white matter change as well as the presence of the Titanium pieces used to repair the berry aneurysm and close the craniotomy as well as the subdural air issue being resolved.
Posted Fri, 3 Aug 2012 in Stroke
Answered by Dr. Shivakumar S. Kupanur 15 hours later

Thanks for the posting the query.

I have gone through your history and also the CT scan reports. Chronic ischemic changes in white matter is caused due to inadequate blood supply to brain tissue. These changes are very common age related findings in most of the people and can present without any symptoms.

CT scan is not that ideal to see those changes, MRI is more appropriate. But, anyway that will give you only radiological diagnosis. Management part concerned, it does not solve any purpose, as it does not need any treatment in most of the cases.

Your recent CT is even more favorable compared to previous one. So, I think, you do not need any active intervention for these ischemic changes at this point.

Regarding your visual complaints, it could be due to TIA (transient Ischemic attack). Other possibility is vasospasm due to bleed which might have resolved. It happens in usually 2-4 weeks. These symptoms might resolve over the period of time.

You need a detailed Neurological evaluation to know the cause for these symptoms. I suggest you to XXXXXXX Neurologist for the same.

I hope I have answered your query. I will be available for follow up queries if any.

Above answer was peer-reviewed by
Follow-up: CT scan done after craniotomy for aneurysm repair. What does the reports mean? 1 hour later
The vasospasm information could be the key as the first instance of visual difficulties was 3 weeks post op and I talked to the Surgeon's Nurse Practioner about them and the headaches I was having at the 4 week surgery follow up, that was when he ordered the most recent CT scan which was done at 6 1/2 weeks. The symptoms have been quite reduced for the last four or five days or about the 7 week XXXXXXX does that fit with what one might expect from a vasospasm?

I used to get about 3 or 4 migraine headaches a year prior to the cardiac PFO repair (it had what the cardiologist described as "significant right to left shunting) and was discovered during testing after the TIA with an echo cardiogram. These headaches were always preceeded by an XXXXXXX of visual disturbances, always the same type and always in both eyes.

The visual disturbances I'm having now tend to affect only one eye, usually the right, but sometimes both are affected or it changes to only the left eye and they are usually preceeded by an XXXXXXX Could these visual issues be caused by migraine headaches?
Answered by Dr. Shivakumar S. Kupanur 14 hours later
Hello again,

Thanks for the detailed history.

From available information, vasospasm was one of the differential diagnoses, which I gave as you had aneurysm. It can be present as delayed effects. However, without clinical examination findings, it will be difficult for me to predict the cause exactly. I can talk only in terms of possibilities.

The headache pattern you have described suggests the migraine headache. Visual effects like blurring, scintillating spectra are common in migraine headache. Your history is typical of migraine.

It’s good to hear that headache is reduced. Consult your treating doctor if it persists.

I hope it helps to solve your doubt. I wish you speedy recovery.

Above answer was peer-reviewed by
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